through the heart, which is excited to increased contraction, and thus the tension within the vessels is raised. In the case of the cold, the pressure is also raised, not by stimulation of the heart, but by the contraction of the vessels, especially those of the stomach and intestine. In the case of warmth, more blood is poured into the aorta by the excited heart, and where we apply cold less blood flows out of the aorta into the veins through the intestinal vessels, and thus it is that in both cases the tension is raised and the faintness removed.
At each meal it is well for the patient to begin with the solids before he proceeds to the fluids, and at breakfast, instead of beginning the meal with a cup of tea or coffee, he should finish a slice of dry toast and a piece of fish, egg, or bacon, before he takes any liquid at all. The same rule should be observed at lunch and dinner. The effect of this course is that the patient is less troubled with weight and flatulence after meals. The explanation of the fact probably is that the solids, entering the stomach first, stimulate it to secretion and movement; whereas, if it already contained a quantity of liquid at the time they were ingested, they would not have this effect, and imperfect digestion would be the result. At dinner, wine or beer may be taken if the patient finds them agree, but in all probability he will be better without them. There are some brain-workers who require them and must have them, but it is better for a good many others to avoid either wine or beer, and to take some effervescing water instead. Not unfrequently we hear the complaint that effervescing water is too cold, and where this is felt to be the case ginger ale or zoedone may be substituted, the color of these beverages and their more pungent taste rendering them more grateful both to the eye and the palate of many persons. In some cases weak claret and-water may be used, and if the water be somewhat warm the mixture will be better for the patients, and will not cause the feeling of coldness in the stomach of which they sometimes complain.
A medicine which has long enjoyed a great reputation in disorder of the liver is nitro-muriatic acid, and I think this reputation well deserved. We do not know how it acts, but in some way or another it does tend to improve the digestion. Ten minims of the dilute nitro-hydrochloric acid, either before or immediately after meals, combined with some aromatic and carminative, such as chloroform and cardamoms or orange, and from five to ten minims of tincture of nux vomica, where the nervous depression is great, is a most efficient remedy.
But, even with all this care in food and drink, with all this attention to what is to be taken and what avoided, with medicine morning, noon, and night, how are we to keep the liver in order without exercise? Sometimes the patient may be able to take walking exercise, but when he does it is generally only for a short time during the day, and of so gentle a character that the respiratory movements are but
